The information provided here is for informational and educational  purposes only. It is not intended to replace, and should not be interpreted or relied upon as medical or professional advice. Always consult with a doctor, healthcare provider, or other medical professional before making any medical decisions. TUMMY TIME IS ALWAYS TO BE DONE WHEN THE CHILD IS AWAKE AND SUPERVISED, IN ACCORDANCE WITH THE AMERICAN ACADEMY OF PEDIATRICS. 

Loading...

 

Waiver/ Release of Liability


Review Privacy Policy

I agree to participate in Move, Develop, Thrive. I understand this is an educational series that is presented for the general population. It is not intended to replace, and should not be interpreted or relied upon as medical or professional advice. The information presented is not for providing physical therapy for any specific condition and my child listed has not been given a comprehensive evaluation or formal diagnosis for which this class is meant to treat.  

May 6, 2024

I understand that tummy time is advised to only be performed while the child is awake and supervised.

I Agree

I understand the information presented in this class and provided via video is meant for me alone and is not to be shared with anyone.

I Agree

 

First Parent's Name

First Name*

Last Name*
First Parent's Age Acknowledgment*
First Parent's Date of Birth*
I certify that I am 18 years of age or older
First Parent's Signature*
Second Parent's Name

First Name*

Last Name*
Second Parent's Date of Birth*
Third Parent's Name

First Name*

Last Name*
Third Parent's Date of Birth*
Fourth Parent's Name

First Name*

Last Name*
Fourth Parent's Date of Birth*
Fifth Parent's Name

First Name*

Last Name*
Fifth Parent's Date of Birth*
Sixth Parent's Name

First Name*

Last Name*
Sixth Parent's Date of Birth*
Seventh Parent's Name

First Name*

Last Name*
Seventh Parent's Date of Birth*
Eighth Parent's Name

First Name*

Last Name*
Eighth Parent's Date of Birth*
Ninth Parent's Name

First Name*

Last Name*
Ninth Parent's Date of Birth*
Tenth Parent's Name

First Name*

Last Name*
Tenth Parent's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Child's name
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!